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        <p>第三部分:NCCL和CDH病因作用机制<br>第一章 应力<br>第一节 应力<br>1.定义：是指传递到构成物体的材料内部的力形成的能量。<br>应力散失——形变<br>2.应力的分类<br>a.同一长轴反方向离心——变长：拉伸应力<br>b.同一长轴反方向向心——变短：压缩应力<br>c.平行的不同平面相反方向作用——撕裂：剪切应力<br>3.应变的定义<br>a.受外部作用（力）后任何可导致形态或尺寸改变的几何构型变化<br>b.应变是应力的结果。<br>4.应变的分类<br>弹性应变<br>塑性应变<br>破裂应变<br>5.应力-应变的有限元分析<br>受压侧形变率低，受拉侧形变率高。<br>1）牙齿受力后颈部为应力集中区<br>2）一侧为压力集中区另一侧拉力集中区<br>3）拉应力应变值大于压应力区<br>4）应变值大产生塑性应变——釉质崩裂<br>第二节 颈部区的解剖考量<br>1.颈部解剖特点<br>a.牙尖处釉柱和牙本质小管与长轴平行<br>b.牙颈部釉柱和牙本质小管与长轴垂直<br>c.颈部釉质薄脆<br>d.颈部牙本质小管多密度高弹性差脆性大<br>2.不同区域的不同组织学特点的釉质和本质拉伸与压缩强度<br>a.垂直于釉柱和小管的力破坏性较大且速度较快<br>b.平行于釉柱和小管的力破坏性相对较小且较慢<br>c.越深层牙本质抵抗拉伸能力越差（进展快）<br>d.拉伸力破坏相对压缩力破坏速度快<br>e.剪切力可产生釉柱错层滑动-破坏（地震带效应）<br>第三节 内部碎裂和咬合因素<br>1.内部碎裂发生的前提<br>a.颈部区域反复咬合负荷应力<br>b.超过釉质和本质的强度极限<br>c.应变超过本质釉质弹性极限<br>2.内部碎裂的定义<br>内部碎裂：非正中咬合力形成的应力集中区出现的牙体组织病理性丢失。<br>3.内部碎裂的影响因素<br>负荷方向及大小<br>负荷的部位<br>负荷频率及时间<br>4.内部碎裂与NCCL的辩证关系<br>a.由CR位到MIP（最大牙尖交错位）或侧方运动有干扰会产生磨耗<br>b.磨耗面与NCCL的辩证<br>c.楔形NCCL几乎100%与非轴向力相关<br>d.紧咬牙与磨牙症是NCCL形成发展过程中的调控因素<br>e.有早接触点的并不一定有NCCL但CR-MIP有干扰多数产生NCCL<br>第四节 应力集中与咬合负荷方向<br>1.咬合负荷方向与应力集中的关系<br>a.咬合负荷位点不同颈部应力集中不同<br>b.咬合负荷同位点不同方向颈部应力集中不同<br>c.单尖单点咬合颈部区应力更加集中应变量大（前磨牙）<br>2.杠杆与内部碎裂的关系<br>a.支点变化NCCL形态发生变化<br>b.咬合力方向决定NCCL位置<br>3.病损形态与应力集中的关系（单角型、多角型、凹型）<br>a.支点变化病损会相应变化<br>b.随时间变化咬合面或切端接触区变化<br>c.内壁由规则的形状变的极不规则（进展线）<br>d.沟底形成硬化牙本质髓腔侧产生反应性牙本质。<br>4.开合案例前牙区NCCL的受力分析（没有咬合为什么有楔缺？）<br>舌肌力量和生物腐蚀联合作用<br>第五节 应力与生物腐蚀、内部碎裂及正畸治疗和牙周的考量<br>1.应力与生物腐蚀（舌侧为何很少有NCCL）<br>a.应力与生物腐蚀协同作用大于单一作用<br>b.颊舌侧所受应力大小相当<br>c.受力时舌侧有舌肌支持<br>d.颊侧缺乏唾液浸润<br>e.舌侧唾液量为颊侧的6倍<br>f.舌侧中和酸的能力较强<br>g.覆合覆盖关系及根分析<br>2.内部碎裂与修复<br>小的时候就要及时修复。<br>3.内部碎裂与正畸<br>a.正畸治疗后患者认为是NCCL和CDH的风险人群。<br>b.正畸治疗时牙齿容易受到过大非轴向负荷<br>4.内部碎裂与牙周<br>a.轴向力牙周膜缓冲<br>b.压应力超过牙周膜弹性限度-骨挠曲<br>c.骨吸收附着龈丧失骨质本质暴露</p>
<p>个人总结：NCCL和CDH的第一个产生机制：应力。有压缩应力、拉伸应力和剪切应力。物体对应力会产生应变，分为弹性应变，塑性应变和破裂应变。其中后两类应变能造成楔缺。受压侧应变较小，受拉侧应变较大。在颈部釉柱和牙本质小管与受力垂直，对应变的抵抗力较弱。颈部区域反复受咬合力，超过釉质的强度极限和牙本质的弹性极限，就会产生内部碎裂。内部碎裂与咬合、正畸、牙周等都有关系。</p>
<p>最后做个广告吧，3000一年，那两场线下课就值回来了。 不过光听可能还是不行，还是要自己看书、实操的。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/011/02.png"></p>
<p>我发文章的四个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的博客园博客地址： <a target="_blank" rel="noopener" href="https://www.cnblogs.com/zwdnet/">https://www.cnblogs.com/zwdnet/</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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